Psoriasis Specialist – About Us

About Our Psoriasis Specialist

 

With more than a decade of experience as a psoriasis specialist, Dr Shobhan Manoharan’s passion lies in providing access to dermatologist treatment programs and teams in locations that are convenient to patients.

 

This was begun in Queensland, where Dr Manoharan services patients in multiple locations across the greater Brisbane region, where they had found that a patient’s ability to attend and commit to medical treatment plans was hindered by the large distances that needed to be regularly travelled to access healthcare.

With a strong conviction that medical treatments should be accessible to all, not just those in the heart of the city, the Manoharans have paved the way in developing a network of clinics to provide local access to treatments for their patients.

How a Psoriasis Specialist can Help Patients with Psoriasis

In the intricate tapestry of dermatological conditions, psoriasis stands as a distinctive and often perplexing pattern. A chronic autoimmune disorder affecting the skin, psoriasis extends beyond the visible surface, impacting both physical and mental well-being. In this in-depth exploration, we unravel the complexities of psoriasis, examining its causes, manifestations, and the myriad treatment strategies that dermatologists employ to address this challenging condition.

Understanding Psoriasis

1. Psoriasis Basics:

Psoriasis is a chronic autoimmune disorder characterised by an accelerated turnover of skin cells. Unlike normal skin cells that take weeks to mature, psoriatic cells move rapidly to the skin’s surface in a matter of days, leading to the formation of thick, red, and scaly patches known as plaques. This heightened cell turnover is a result of the immune system mistakenly attacking healthy skin cells, triggering inflammation and the characteristic symptoms of psoriasis.

2. Genetic Predisposition:

While the exact cause of psoriasis remains elusive, a strong genetic component is evident. Individuals with a family history of psoriasis are at an increased risk of developing the condition. Specific genetic markers associated with psoriasis susceptibility have been identified, highlighting the role of inherited factors in its pathogenesis.

3. Immune System Dysfunction:

Psoriasis is fundamentally an immune-mediated disorder. In a normal immune response, white blood cells defend the body against foreign invaders. In psoriasis, however, these cells mistakenly target healthy skin cells, setting off a cascade of events leading to inflammation and abnormal skin cell growth. The immune system’s misfire in psoriasis involves T cells, a type of white blood cell, and their interaction with skin cells.

4. Triggers and Environmental Factors:

While genetics play a significant role, various environmental factors and triggers can exacerbate or trigger psoriasis flare-ups. These triggers include stress, infections, certain medications (such as lithium and beta-blockers), and trauma to the skin. Understanding and managing these triggers is crucial in the holistic management of psoriasis.

 

The Clinical Landscape of Psoriasis

1. Plaque Psoriasis:

Plaque psoriasis is the most common form, accounting for about 80% of all cases. It presents as raised, red patches covered with a silvery-white buildup of dead skin cells. These plaques can occur anywhere on the body, but commonly affect the scalp, elbows, knees, and lower back.

2. Guttate Psoriasis:

Guttate psoriasis often manifests as small, red spots resembling drops. It is frequently triggered by bacterial infections, such as strep throat. Guttate psoriasis is more common in children and young adults.

3. Inverse Psoriasis:

Inverse psoriasis appears as smooth, red patches in skin folds, such as the armpits, groin, or under the breasts. Unlike typical psoriasis plaques, these areas may lack the characteristic scaling.

4. Pustular Psoriasis:

Pustular psoriasis is characterised by pus-filled blisters surrounded by red skin. It can be localized to specific areas or cover large portions of the body. This form of psoriasis may be triggered by medications, sudden withdrawal of systemic steroids, or infections.

5. Erythrodermic Psoriasis:

Erythrodermic psoriasis is a rare but severe form that can cover the entire body with a red, peeling rash. It may cause intense itching or burning and can be life-threatening. This form of psoriasis often requires immediate medical attention.

 

Beyond the Skin: The Systemic Impact

Psoriatic Arthritis:

Psoriatic arthritis is a common comorbidity of psoriasis, affecting up to 30% of individuals with skin condition. This inflammatory arthritis can cause joint pain, stiffness, and swelling. Early detection and management are crucial to prevent joint damage and improve overall quality of life.

Cardiovascular Comorbidities:

Psoriasis has been associated with an increased risk of cardiovascular diseases, including heart attack and stroke. Chronic inflammation, a hallmark of psoriasis, may contribute to the development of cardiovascular comorbidities. Dermatologists and healthcare professionals collaborate to manage both the skin condition and its associated systemic risks.

Metabolic Syndrome and Diabetes:

Individuals with psoriasis have an elevated risk of developing metabolic syndrome, a cluster of conditions that includes high blood pressure, elevated blood sugar, and abnormal cholesterol levels. This increased risk extends to the development of type 2 diabetes.

 

How a Psoriasis Specialist Make a Diagnosis

Clinical Examination:

Dermatologists diagnose psoriasis primarily through a clinical examination. The distinctive appearance of plaques and the distribution of lesions often provide clear indications of psoriasis. However, further evaluation may be necessary to confirm the diagnosis and rule out other skin conditions.

Skin Biopsy:

In some cases, dermatologists may perform a skin biopsy to confirm the diagnosis. This involves taking a small sample of skin tissue for examination under a microscope. A biopsy helps differentiate psoriasis from other skin disorders with similar presentations.

Psoriasis Severity Index:

The Psoriasis Area and Severity Index (PASI) is a commonly used tool for assessing the severity of psoriasis. Dermatologists evaluate factors such as the extent of body surface area affected, plaque thickness, and erythema (redness) to determine the overall severity of the condition.

 

Psoriasis Specialist Treatment Strategies

1. Topical Treatments:

Topical treatments are often the first line of defense for mild to moderate psoriasis. These include corticosteroids, vitamin D analogs, retinoids, and coal tar preparations. Topical treatments are applied directly to the affected skin and help reduce inflammation and scale.

2. Phototherapy (Light Therapy):

Phototherapy involves exposing the skin to ultraviolet (UV) light, either natural sunlight or artificial UV light. UVB phototherapy has proven effective in slowing the rapid skin cell turnover associated with psoriasis.

3. Systemic Medications:

For more severe cases, systemic medications may be prescribed. These include oral medications such as methotrexate, cyclosporine, and acitretin, as well as newer biologic drugs that target specific aspects of the immune system involved in psoriasis.

4. Combination Therapy:

Dermatologists often employ combination therapy, combining different treatment modalities to enhance efficacy. For example, combining phototherapy with topical treatments or systemic medications can provide a comprehensive and targeted approach to psoriasis management.

5. Biologic Therapies:

Biologic therapies represent a significant advancement in psoriasis treatment. These medications, administered by injection or infusion, target specific immune pathways involved in psoriasis. Biologics have shown remarkable efficacy in managing symptoms and improving quality of life for individuals with moderate to severe psoriasis.

 

Lifestyle Modifications and Self-Care

Stress Management:

Stress is a known trigger for psoriasis flare-ups. Techniques such as meditation, deep breathing exercises, and yoga can help manage stress and contribute to better psoriasis management.

Skin Care Practices:

Gentle skincare practices, including moisturizing and avoiding harsh soaps, can help alleviate dryness and reduce the risk of skin irritation. Dermatologists often provide guidance on suitable skincare routines for individuals with psoriasis.

Maintaining a Healthy Diet:

While there is no specific psoriasis diet, maintaining a healthy and balanced diet can contribute to overall well-being. Some individuals with psoriasis report improvements with dietary changes, such as reducing alcohol intake and avoiding certain trigger foods.

 

The Psychological Impact of Psoriasis

Stigma and Social Impact:

The visible nature of psoriasis can lead to social stigma and impact interpersonal relationships. Individuals may experience feelings of embarrassment or self-consciousness, emphasizing the importance of addressing the psychological impact of the condition.

Depression and Anxiety:

Living with a chronic skin condition can take a toll on mental health. Depression and anxiety are common among individuals with psoriasis. Dermatologists may collaborate with mental health professionals to provide holistic care that addresses both the physical and emotional aspects of psoriasis.

 

Advances in Psoriasis Research

Genetic Studies:

Ongoing genetic studies aim to unravel the intricate genetic factors contributing to psoriasis susceptibility. Understanding the genetic underpinnings of the condition may pave the way for targeted therapies and personalised treatment approaches.

Immunology Research:

Advances in immunology research continue to uncover the complex immune mechanisms involved in psoriasis. This knowledge informs the development of biologic therapies that target specific components of the immune system, providing more effective and targeted treatment options.

Digital Health Solutions:

The integration of digital health solutions, such as telemedicine and mobile apps, is transforming psoriasis care. These technologies enhance remote monitoring, facilitate virtual consultations, and empower individuals to actively participate in their treatment plans.

 

Conclusion

A psoriasis specialist, armed with a deep understanding of the condition, play a pivotal role in unraveling the complexities of psoriasis and guiding individuals on a transformative journey toward skin health and overall well-being.

From accurate diagnosis and personalised treatment plans to the exploration of emerging therapies and lifestyle modifications, the management of psoriasis is a multifaceted endeavor. The psychological impact of psoriasis underscores the need for a holistic approach that addresses not only the visible symptoms but also the emotional well-being of individuals navigating this chronic condition.

As research continues to unlock the mysteries of psoriasis, and innovative therapies emerge, the landscape of psoriasis care evolves. Dermatology, at the forefront of this evolution, continues to illuminate the path toward relief, empowerment, and a life unburdened by the complexities of psoriasis. Through the collaborative efforts of dermatologists, healthcare professionals, and individuals themselves, the journey toward effective psoriasis management becomes a shared venture—one that holds the promise of a brighter and more comfortable future for those touched by this intricate skin condition.